Articles: emergency-services.
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Relatively few emergency physicians are aware of the spectrum of regional anesthesia and the advantages it has to offer in the day-to-day practice of the specialty. Understanding the types of block and the principles that apply to neural blockade are only a beginning in the appropriate use of blockade techniques. A detailed knowledge of anatomy is essential to successful and safe practice; however, only repeated performance of the blocks will lead to predictable success!
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The chest radiological findings and outcomes of 120 consecutive patients attending the Accident & Emergency Department with anterior chest pain were recorded prospectively to investigate the value of routine chest radiography in their management. Twenty-one patients (17.5%) were excluded because of incomplete information. Thirty-seven radiological abnormalities were identified in 33 (33%) of the remaining 99 chest X-rays. ⋯ The casualty officer's interpretation of 70 (70%) of the chest X-rays was correct, but 36 errors were made interpreting the other 29 chest X-rays. Of these errors, 19 were false negative errors, resulting in the mismanagement of two patients and 17 false positive errors, resulting in the mismanagement of four patients. It appears that a routine chest X-ray provides little information of practical value in the management of patients with anterior chest pain attending an Accident & Emergency Department, unless the training of medical students and junior doctors in the interpretation of chest X-rays is improved.
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Emergency and radiology department directors at 517 acute-care US teaching hospitals were sent identical questionnaires surveying practice patterns of ED plain film radiograph interpretation. Fifty-seven percent of ED directors and 51% of radiology department (RD) directors responded. Both groups reported that the most common practice pattern (60%) was alternating responsibility for immediate interpretation between emergency physicians and radiologists during a 168-hour week. ⋯ Interpretation discrepancy rates between emergency physicians and radiologists were estimated to be 4% to 6%. The large amount of variation among hospitals in ED radiograph interpretation systems suggests that these systems were not designed with quality of care concerns as their primary criterion. As a consequence, objective patient outcome and process measures need to be developed and measured to ensure that a particular internal system for ED radiograph interpretation is providing an acceptably high standard of patient care.